The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation

Amar Krishnaswamy, Yasser Sammour, Antonio Mangieri, Amer Kadri, Antonette Karrthik, Kinjal Banerjee, Manpreet Kaur, Francesco Giannini, Beniamino Pagliaro, Marco Ancona, Matteo Pagnesi, Alessandra Laricchia, Giora Weisz, Megan Lyden, Najdat Bazarbashi, Mohamed Gad, Keerat Ahuja, Stephanie Mick, Lars Svensson, Rishi PuriGrant Reed, John Rickard, Antonio Colombo, Samir Kapadia, Azeem Latib

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objectives: The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI). Background: Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI. Methods: Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI. Results: A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%). Conclusions: Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.

Original languageEnglish (US)
Pages (from-to)1046-1054
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume13
Issue number9
DOIs
StatePublished - May 11 2020
Externally publishedYes

Keywords

  • atrial pacing
  • electrophysiology study
  • permanent pacemaker implantation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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